Detailed Medical Information on Laura

Many of you have expressed an interest in a more detailed explanation of what has happened and is happening with Laura.  I have attempted here to provide a (somewhat) simple explanation of what's going on and to answer some miscellaneous medical questions.

What does the gallbladder do?

The gallbladder is a sac located under the liver that stores the bile secreted by the liver.  Bile helps in the digestive process, especially with fat and protein.  During a meal, the gallbladder contracts and delivers bile through the common bile duct into the intestines.

How are gallstones formed?

If bile is formed abnormally, gallstones are the result.  There is a wide range of causes for abnormal bile production, and we do not know what caused Laura's problem.  Gallstones are "pebbles" within the gallbladder.  Gallstones that emerge from the gallbladder usually pass through the small intestine and out of the body, causing no symptoms.  What happened to Laura is that a gallstone became lodged in the common bile duct, which is connected to the pancreas and the small intestine. 

What does the pancreas do?

The pancreas is a large gland behind the stomach and close to the top part of the small intestine.  The pancreas produces digestive juice (enzymes) into the small intestine through a tube called the pancreatic duct.  Pancreatic enzymes join bile from the gallbladder to help digest food. 

The pancreas also releases hormones called insulin and glucagon into the bloodstream.  These hormones help the body to regulate glucose (food energy).  Many of you are familiar with diabetes, which is a serious disease that affects insulin regulation.  Because of its crucial role in the release and regulation of insulin, as well as other aspects of digestion, the pancreas is not an organ that can be removed.

What is pancreatitis, and how did Laura get sick?

Pancreatitis is simply an inflamation of the pancreas.  Normally, pancreatic enzymes do not become active until they reach the small intestine.  If the enzymes cannot exit the pancreas, they attack and damage the pancreatic tissue.  Laura had a gallstone stuck in her common bile duct, which prevented her pancreas from draining its enzymes. 

How serious is Laura's pancreatitis?  When can she go home?

Pancreatitis can be a life-threatening illness with severe complications.  Sometimes, pancreatitis will resolve on its own with a couple of days of hospital care.  Unfortunately, Laura's pancreatitis is quite severe.  During the first week of Laura's stay in the hospital, she was at risk of kidney, liver, and lung failure, as well as pancreatic failure.  The breathing machine she was using every couple of hours was helping to prevent her from being put on a respirator (which has its own complications).  The fluid that had to be drained from her stomach and from underneath her lungs was a side effect of the infection, and it was threatening her organs.

Right now, the pancreas is the only organ of concern.  Laura will have to stay in the hospital until the inflammation in her pancreas is either completely gone or is at a level that can be managed with home care.

Why did her doctor "shut down" Laura's pancreas with medication?

As long as the pancreas is still working, it produces enzymes.  Since Laura's pancreatic enzymes had nowhere to go, they would have continued to attack the pancreatic tissue.  Now that the problematic gallstone is no longer in the bile duct, her doctor can allow the pancreas to try and resume normal functioning.

Why can't Laura eat or drink anything?

The pancreas is a very sensitive organ.  If it recognizes that anything has come through the digestive tract (even spit), it goes to work.  As long as Laura has this pancreatic infection, the pancreas needs to rest.


Miscellaneous Answers

What do white blood cells do?

White blood cells (WBCs) are one of the most important parts of our immune system.  When they sense an infection, they attack and try to eliminate it.  This results in an elevated white blood cell count (WBC count), like we have seen with Laura.  As long as the WBC count is elevated, the doctors know the pancreas is still infected.

Why didn't Laura's doctor fight her fever?

When the WBCs are involved in fighting an infection, they are working fast and furiously.  This causes an increase in the body's temperature, which also helps to fight the infection.  If her doctor was to try and decrease Laura's body temperature too quickly, they would have prevented her immune system from working correctly.  As much as we can do with medicine, sometimes the best course of action is to let the body do what it's supposed to do.  Now that Laura does not have a daily fever, her doctor is monitoring the infection through her WBC count.

What is a pseudocyst?

Pseudocysts are accumulations of fluid and tissue that may develop in the pancreas.  In many instances, pseudocysts are resolved on their own by the immune system; however, some untreated pseudocysts can cause enzymes and toxins to enter the bloodstream and affect the heart, lungs, kidneys, or other organs.  Laura's doctor is watching her pseudocyst to ensure that this does not happen.

You didn't answer my question...

If there is something I missed, or if you need further explanation, please leave a comment.  I will do my best to get an answer to you as soon as possible.  If you would like to do some further reading on your own, a good source is the website of the Mayo Clinic: http://www.mayoclinic.com/.